Lactate/pyruvate ratio as a marker of tissue hypoxia in circulatory and septic shock

Anaesthesia and Intensive Care
R RimachiD De Backer

Abstract

In this prospective, observational study, we measured arterial lactate and pyruvate concentrations within the first four hours of shock and at four hour intervals during the first 24 hours in 26 patients with septic and 13 with cardiogenic shock. We also studied 10 intensive care unit patients with normal lactate levels as controls. Seven patients (18%) died during the first 24 hours of shock, 12 (31%) patients died later in the intensive care unit and 21 (54%) were discharged alive from the intensive care unit. Blood lactate values were higher at shock onset in the non-survivors than in the survivors (P=0.02) and remained significantly elevated throughout the study. The lactate/pyruvate ratio at shock onset was significantly higher in the non-survivors (24 [17 to 34] vs 15 [10 to 19], P=0.01) than in the survivors. All patients with cardiogenic shock had hyperlactataemia at the onset of shock, and 69% had a high lactate/pyruvate ratio. Only 65% of patients with septic shock had hyperlactataemia at the onset of shock and 76% of these also had a high lactate/pyruvate ratio. In conclusion, the lactate/pyruvate ratio confirms that hyperlactataemia is frequently, but not solely, due to hypoxia, especially at the onset of shock.

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Citations

Jun 16, 2019·Critical Care : the Official Journal of the Critical Care Forum·Daniel De Backer, Pierre Foulon
Nov 15, 2014·Critical Care : the Official Journal of the Critical Care Forum·Mercedes Garcia-AlvarezRinaldo Bellomo
Sep 17, 2013·Analytical and Bioanalytical Chemistry·Liza RassaeiAlbert van den Berg
Jan 4, 2018·Critical Care : the Official Journal of the Critical Care Forum·Daniel De Backer
Jun 5, 2019·Critical Care Medicine·Lars FalkLars Mikael Broman
Mar 14, 2019·International Anesthesiology Clinics·Julian AriasDaniel De Backer
Jul 2, 2019·The Journal of International Medical Research·Huaiwu HeCan Ince
Jul 12, 2019·Journal of Clinical Monitoring and Computing·Philippe PortranJean-Luc Fellahi
Jul 13, 2020·Burns : Journal of the International Society for Burn Injuries·Eva Herrero De LucasAbelardo García-de-Lorenzo
Mar 27, 2015·Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine·Xavier WittebolePhilippe Hantson
Apr 23, 2021·International Journal of Emergency Medicine·Thomas LoebMichel Baer

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